Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/28—Surgical forceps
  • A61B17/29—Forceps for use in minimally invasive surgery
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
  • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
  • A61B18/14—Probes or electrodes therefor
  • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
  • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
  • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
  • A61B18/14—Probes or electrodes therefor
  • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
  • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
  • A61B2017/003—Steerable
  • A61B2017/00318—Steering mechanisms
  • A61B2017/00323—Cables or rods
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/28—Surgical forceps
  • A61B17/29—Forceps for use in minimally invasive surgery
  • A61B2017/2926—Details of heads or jaws
  • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B2018/00053—Mechanical features of the instrument of device
  • A61B2018/00059—Material properties
  • A61B2018/00071—Electrical conductivity
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B2018/00053—Mechanical features of the instrument of device
  • A61B2018/00184—Moving parts
  • A61B2018/00202—Moving parts rotating
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
  • A61B2018/00601—Cutting
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
  • A61B2018/00607—Coagulation and cutting with the same instrument
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
  • A61B2018/0063—Sealing
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61B2018/0091—Handpieces of the surgical instrument or device
• • A—HUMAN NECESSITIES
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  • A61B2018/0091—Handpieces of the surgical instrument or device
  • A61B2018/00916—Handpieces of the surgical instrument or device with means for switching or controlling the main function of the instrument or device
  • A61B2018/0094—Types of switches or controllers
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61B2018/0091—Handpieces of the surgical instrument or device
  • A61B2018/00916—Handpieces of the surgical instrument or device with means for switching or controlling the main function of the instrument or device
  • A61B2018/0094—Types of switches or controllers
  • A61B2018/00946—Types of switches or controllers slidable
• • A—HUMAN NECESSITIES
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  • A61B2018/0091—Handpieces of the surgical instrument or device
  • A61B2018/00916—Handpieces of the surgical instrument or device with means for switching or controlling the main function of the instrument or device
  • A61B2018/0094—Types of switches or controllers
  • A61B2018/00952—Types of switches or controllers rotatable
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
  • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
  • A61B18/14—Probes or electrodes therefor
  • A61B2018/1405—Electrodes having a specific shape
  • A61B2018/1412—Blade
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
  • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
  • A61B18/14—Probes or electrodes therefor
  • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
  • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
  • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
  • A61B18/14—Probes or electrodes therefor
  • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
  • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
  • A61B2018/1455—Probes having pivoting end effectors, e.g. forceps including means for cutting having a moving blade for cutting tissue grasped by the jaws
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  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
  • A61B2018/1823—Generators therefor
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  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
  • A61B2018/1861—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves with an instrument inserted into a body lumen or cavity, e.g. a catheter

Definitions

• the invention relates to electrosurgical forceps for grasping biological tissue and for delivering microwave energy into the grasped tissue to coagulate or cauterise or seal the tissue.
• the forceps may be used to apply pressure to close one or more blood vessels before applying electromagnetic radiation (preferably microwave energy) to seal the blood vessel (s) .
• the forceps may also be arranged to cut tissue after coagulate or sealing, e.g. using
• the invention may be applied to forceps that can be inserted down the instrument channel of an endoscope, a gastroscope or a bronchoscope, or may be used in laparoscopic surgery or open surgery.
• Electrosurgical instruments are instruments that are used to deliver radiofrequency and/or microwave frequency energy to biological tissue, for purposes such as cutting biological tissue or coagulating blood. Radiofrequency and/or microwave frequency energy is supplied to the electrosurgical instrument using a transmission line, such as a coaxial cable, waveguide, microstrip line or the like.
• an electrosurgical instrument may include forceps capable of delivering heat energy biological tissue grasped between jaws of the forceps.
• forceps capable of delivering heat energy biological tissue grasped between jaws of the forceps.
• radiofrequency (RF) energy may be delivered from a bipolar electrode arrangement in the jaws of the forceps.
• the RF energy may be used to seal vessel by thermal denaturation of extracellular matrix proteins (e.g. collagen) within the vessel wall.
• the heat energy may also cauterise the grasped tissue and facilitate coagulation.
• the jaws may include one or more microwave emitter structures, which are arranged to radiate microwave EM energy into biological tissue grasped between the jaws, in order to seal the tissue.
• gynaecology gynaecology
• endourology gastrointestinal surgery
• ENT procedures etc.
• these devices can have differing physical construction, size, scale and complexity.
• the LigaSure vessel sealing technology manufactured by Covidien
• the Thunderbeat platform from Olympus.
• the LigaSure system is a bipolar forceps arrangement in which current is delivered to seal tissue while pressure is applied.
• the Thunderbeat platform simultaneously delivers thermal energy generated using an ultrasonic source, and bipolar electrical energy.
• US 6,585,735 describes an endoscopic bipolar forceps in which the jaws of the forceps are arranged to conduct bipolar energy through the tissue held therebetween.
• EP 2 233 098 describes microwave forceps for sealing tissue in which the sealing surfaces of the jaws include one or more microwave antennas for radiating microwave energy into tissue grasped between the jaws of the forceps.
• WO 2015/097472 describes electrosurgical forceps in which one or more pairs of non-resonant unbalanced lossy
• transmission line structure are arranged on the inner surface of a pair of jaws.
• the present disclosure provides various improvements for control of an electrosurgical apparatus, and in particular an electrosurgical forceps instrument.
• the present disclosure provides an electrosurgical forceps instrument that combines a robust jaw opening mechanism with an microwave energy delivery mechanism.
• the present disclosure provides a handpiece that combines rotation control of an electrosurgical
• an electrosurgical forceps instrument comprising: a flexible shaft defining a lumen; a coaxial cable for conveying microwave energy disposed within the lumen of the flexible shaft; a rigid bracket mounted at a distal end of the flexible shaft; a pair of jaws pivotably mounted on the rigid bracket, the pair of jaws being movable relative to each other to open and close a gap between opposing inner surfaces thereof; and an actuating element disposed within the lumen of the flexible shaft and extending therefrom through the rigid bracket to operably engage the pair of jaws, wherein the pair of jaws comprises a first jaw having an energy delivery structure attached to an inner surface therefore, the energy delivery structure comprising a flexible dielectric substrate having a first electrode and an second electrode formed thereon, wherein the energy delivery structure is connected to receive the microwave energy from the coaxial cable, and wherein the first electrode and the second electrode are arranged to emit the microwave energy received by the energy delivery structure into the gap between the pair of jaws.
• This structure can provide a robust jaw opening mechanism, where the pair of jaws are securely mounted with respect to a distal portion of the shaft in a manner that reduces or eliminates the risk of them being deflected e.g. to one side during use.
• the jaws themselves may be formed as rigid claw-like structures, e.g. from biocompatible metal, such as stainless steel.
• the jaws may act to protect the energy delivery structure, and thus allow that structure to possess a flexibility that enables it to deform as the jaws move relative to each other without affecting the delivery of microwave power.
• the pair of jaws may be arranged to grip
• biological tissue e.g. a blood vessel
• microwave energy across the gap between the inner surface of the jaws to coagulate the tissue contained within the vessel, i.e.
• the vessel may be cut, e.g. using a blade or RF energy delivered from the same electrodes that deliver the microwave energy.
• a movable blade may be incorporated into the forceps.
• the pair of jaws may comprise a second jaw disposed opposite the first jaw, the second jaw having an identical structure to the first jaw.
• the pair of jaws may comprise a second jaw having an energy delivery structure attached to an inner surface therefore, the energy delivery structure comprising a flexible dielectric substrate having a first electrode and an second electrode formed thereon, wherein the energy delivery structure is connected to receive the microwave energy from the coaxial cable, and wherein the first electrode and the second electrode are arranged to emit the microwave energy received by the energy delivery structure into the gap between the pair of jaws.
• both jaws may have a flexible dielectric substrate, each with a single electrode. The microwave energy may then be
• the rigid bracket may be a pronged or U-shaped structure mounted at e.g. affixed to the distal end of the flexible shaft.
• An axle or pivot pin may be mounted between the prongs or legs of the U-shaped structure.
• the pair of jaws may be pivotably mounted about this same axis, i.e. they may pivot about a common axis.
• the pair of jaws may move in a symmetrical manner with respect to the axis.
• the pair of jaws may comprise a first jaw and a second jaw
• the actuating element may comprises a first control wire connected to the first jaw and a second control wire connected to the second jaw.
• the first control wire and second control wire may be movable in a longitudinal direction relative to the bracket to effect opening and closing of the pair of jaws.
• Each control wire may be secured to, e.g. bonded to or hooked on to, a proximal portion of its respective jaw.
• the control wires may be rigid to enable both a push force and a pull force to be transferred to the pair of jaws.
• the actuating element may comprise a main control wire that extends through the lumen of the flexible shaft.
• the main control wire may bifurcate at a distal end thereof to form the first control wire and the second control wire.
• a retaining frame may be mounted within a proximal portion of the lumen to hold the coaxial cable and the actuating element in a fixed orientation relative to each other.
• the retaining frame may have a first mounting region shaped to receive and retain the coaxial cable and a second mounting region shaped to receive and retain the actuating element.
• a sleeve may be formed around the retaining frame, coaxial cable and actuating element within the lumen of the flexible shaft. This arrangement may reduce friction as the flexible shaft is manipulated, and may assist in relative sliding between the actuating element and coaxial cable.
• the retaining frame may have a distal end spaced
• a distal portion of the flexible shaft adjacent to the rigid bracket has an emptier lumen and can therefore exhibit more flexibility. This may facilitate locating the instrument in awkward positions.
• the first and second electrodes may be elongate
• the substrate within the jaw may be parallel transmission lines, and may form a co-planar line structure on the inner surface.
• the distance of separation between the co-planar lines or parallel transmission lines may be chosen to provide RF cutting functionality, i.e. to enable an E-field produced upon applying RF energy to be high enough to produce tissue cutting or dissection/resection.
• the parallel transmission electrodes may be arranged such that the electrodes that opposed each other across the gap between the jaws are of opposite polarity, i.e. a positive charge on one line faces a negative charge of the opposing line.
• the tissue cutting action may be augmented by the opposing E-fields on the two opposite faces when the jaws are in close proximity, e.g.
• first and second electrodes on the jaw may be equal to or less than 0.5 mm.
• the flexible dielectric substrate may comprise a proximal portion extending between a distal end of the coaxial cable and a proximal end of the inner surface, wherein the proximal portion is deformable upon opening and closing of the pair of jaws.
• the proximal portion may pass through the rigid bracket.
• the coaxial cable may thus terminate within the lumen of the flexible shaft.
• the flexible dielectric substrate has a pair of
• the pair of conductive tracks may be formed on opposite sides of the flexible dielectric substrate.
• the pair of conductive tracks may comprise a first conductive track electrically connected to an inner conductor of the coaxial cable, and a second conductive track
• the first conductive track may be electrically connected to the first electrode and the second conductive track is electrically connected to the second electrode. These connections may occur at a junction at the inner surface of the jaw.
• the flexible dielectric substrate may be a ribbon of insulating material having electrically conductive material fabricated thereon to provide the first electrode and the second electrode.
• the ribbon may have a width greater than a width of the pair of conductive tracks.
• There may be an additional piece of dielectric (e.g. ceramic or PTFE or ceramic loaded PTFE) mounted on the inner jaw element.
• the material preferably has a low dissipation factor or tan delta, i.e. 0.001 or lower, and has a high dielectric strength or breakdown voltage, i.e. up to 100 kV/mm or more.
• Polyimide or similar materials can be used.
• the first jaw (or both or the pair of jaws) may have a longitudinal slot formed therein for permitting passage of a cutting blade.
• the cutting blade may be slidably mounted on the first jaw.
• the blade may be operable using a blade control wire that is disposed within and extends from the lumen to operably engage the blade.
• the first jaw comprises a cover portion, e.g. at a distal end thereof.
• the cover portion may be sized to retain the blade in a retracted position.
• the blade may be biased into the retracted
• the blade control wire may be operably coupled to the actuating element such that movement of the blade away from the retracted position urges the pair of jaws towards a closed position.
• the pair of jaws may be dimensioned to fit within an instrument channel of a surgical scoping device, e.g. an endoscope, gastroscope, bronchoscope or the like.
• a surgical scoping device e.g. an endoscope, gastroscope, bronchoscope or the like.
• the invention may provide a handpiece for controlling an electrosurgical instrument, the handpiece comprising: a body; a flexible shaft extending from a proximal end of the body; a coaxial cable extend through a lumen defined by the flexible shaft, the coaxial cable being for connection to an electrosurgical instrument locatable at a distal end of the flexible shaft; a control rod extending through the lumen, the control rod being for connection to an electrosurgical instrument locatable at a distal end of the flexible shaft; an actuating element slidably mounted on the body; and a rotator rotatably mounted on the body, wherein the coaxial cable and the flexible shaft are mounted to slide relative to the body with the actuating element and rotate relative to the body with the rotator, and wherein the control rod has a proximal portion that is mounted in a longitudinally fixed position relative to the body.
• the handpiece can deliver power to an electrosurgical instrument at the distal end of the flexible shaft in combination with both a longitudinal (axial) force (
• the longitudinal force may be used to control an end effector on the
• the rotational force may be used to control the orientation of the
• connection between the components in the handpiece are such that the flexible shaft and the coaxial cable are slidably relative to the control rod.
• the position of the control rod can change relative to the flexible shaft, which can thus provide a physical movement at the distal end thereof for operating the instrument.
• the body may be a barrel-type housing that lies on a axis that is aligned with the flexible shaft as it extends away from the body.
• a rotation axis of the rotator may be aligned with or coaxial within the axis of the body.
• the rotator may be a collar or ring mounted on an outer surface of the body. The rotator may be retained in a longitudinal (axial)
• the body may have a circumferential recess in which the rotator is seated.
• the control rod may be rotatable with respect to the body. This means that all of flexible shaft, control rod and coaxial cable rotate relative to the body upon rotation of the rotator. This can prevent twisting of components within the flexible shaft.
• the proximal portion of the control rod may be mounted on the rotator. If the rotator is axially fixed relative to the body, this attachment means that the control rod will rotate with the rotator but will not slide relative to the body.
• the proximal portion may include a radial extension that passes through the flexible shaft in order to connect to the rotator.
• the handpiece may comprise an internal shaft that housing a proximal portion of the flexible shaft.
• the internal shaft may be coupled to the rotator to rotate with it.
• the internal shaft may be axially slidably along a track formed within the rotator .
• the actuating element may comprise a shaft mounted to slide in a longitudinal direction (i.e. the axial direction mentioned above) within the housing.
• the actuating element and body may have grip elements, e.g. finger rings or the like, for a user to hold while operating the device.
• the handpiece may comprise a power input port on the actuating element.
• the power input port may be a QMA
• the power input port may be connected to transfer power received therein to the coaxial cable.
• a proximal end of the coaxial cable may be connected to the actuating element to receive power from the power input port .
• the proximal end of the coaxial cable may be connected to the actuating element via a rotatable coupling to permit relative rotation therebetween.
• the power input port may connect to an external coaxial cable e.g. from an electrosurgical generator.
• a connection direction into the power input port may extend perpendicularly to the direction in which the actuating element is slidable relative to the body.
• the power input port may be at an underside of the actuating element.
• a filter for blocking unwanted frequencies of energy may be incorporated into the handpiece.
• the filter may be located in the actuating element, so that it moves with the coaxial cable.
• the filter is an RF blocking circuit mounted in the actuator element between the power input port and the coaxial cable. If the electrosurgical generator is capable of delivery both RF and microwave energy, but the electrosurgical instrument is designed only to use microwave energy, the RF blocking circuit provides a safety mechanism to prevent incorrect use. This aspect of the invention may share any one or more of the features discussed above.
• the handpiece discussed above may be used in an
• electrosurgical apparatus comprising an electrosurgical generator for supplying microwave energy and a surgical scoping device having an instrument cord for insertion into a patient' s body, the instrument cord having an instrument channel extending therethrough.
• the handpiece may be
• handpiece may pass through the instrument channel of the surgical scoping device.
• An electrosurgical forceps
• the instrument e.g. such as that discussed herein, may be connected at a distal end of the flexible shaft of the handpiece.
• the actuating element of the handpiece (which is also the actuating element of the instrument) is connected to control opening and closing of the electrosurgical forceps instrument.
• the rotator operates to control rotation of the electrosurgical forceps instrument relative to the instrument channel .
• surgical scoping device may be used herein to mean any surgical device provided with an insertion tube that is a rigid or flexible (e.g. steerable) conduit that is introduced into a patient's body during an invasive procedure.
• the insertion tube may include the instrument channel and an optical channel (e.g. for transmitting light to illuminate and/or capture images of a treatment site at the distal end of the insertion tube.
• the instrument channel may have a diameter suitable for receiving invasive surgical tools. The diameter of the instrument channel may be 5 mm or less.
• the term “inner” means radially closer to the centre (e.g. axis) of the instrument channel and/or coaxial cable.
• the term “outer” means radially further from the centre (axis) of the instrument channel and/or coaxial cable.
• conductive is used herein to mean electrically conductive, unless the context dictates otherwise.
• proximal and distal refer to the ends of the elongate probe. In use the proximal end is closer to a generator for providing the RF and/or microwave energy, whereas the distal end is further from the generator.
• microwave may be used broadly to indicate a frequency range of 400 MHz to 100 GHz, but
• GHz preferably the range 1 GHz to 60 GHz.
• Specific frequencies that have been considered are: 915 MHz, 2.45 GHz, 3.3 GHz, 5.8 GHz, 10 GHz, 14.5 GHz and 24 GHz. In contrast, this
• radiofrequency or "RF” to indicate a frequency range that is at least three orders of magnitude lower, e.g. up to 300 MHz, preferably 10 kHz to 1 MHz, and most preferably 400 kHz.
• Fig. 1 is a schematic diagram of an electrosurgical system that is an embodiment of the invention
• Figs. 2a, 2b and 2c show perspective views of an
• Figs. 3a, 3b show perspective views of an instrument tip of an electrosurgical forceps instrument that is another embodiment of the invention
• Fig. 3c shows a perspective view of a jaw of the
• Figs. 4a-4c are schematic diagrams illustrating a safety mechanism that can be used to actuate a sliding blade of the instrument tip of Figs. 3a and 3b;
• Fig. 5 shows a perspective view of an instrument tip of an electrosurgical forceps instrument that is another
• FIG. 6a shows a perspective view of a handpiece of an electrosurgical apparatus that is an embodiment of the invention
• Fig. 6b shows a part cutaway view of the handpiece of Fig. 6a, revealing parts of the internal structure of the handpiece;
• Fig. 7a is a top view of a circuit board that can be mounted within a handpiece of an electrosurgical apparatus that is an embodiment of the invention
• Figs. 7b and 7c are perspective views of the circuit board of Fig. 7a;
• Fig. 8A is a schematic side view of an energy delivery structure that can be used in an electrosurgical forceps instrument that is an embodiment the invention, and includes an inset showing a magnified cross-sectional view through an electrode strip of the energy delivery structure;
• Fig. 8B is a graph showing return loss for the energy delivery structure of Fig. 8A when in tissue and when immersed in saline;
• Figs . 9A and 9B show top and bottom views of an example electrode strip suitable for use in the energy delivery structure of Fig. 8A;
• Fig. 9C is a magnified cross-sectional view through a stripline-type transmission line used in the electrode strip of Figs. 9A and 9B .
• Fig. 1 is a schematic diagram of a complete
• the electrosurgical system 100 that is an embodiment of the invention.
• the system is arranged to treat biological tissue (e.g. a tumour, lesion or fibroid) using microwave frequency energy from an instrument tip.
• the system 100 comprises a generator 102 for controllably supplying microwave EM energy.
• the generator 102 may also be capable of supplying RF electromagnetic (EM) energy.
• EM electromagnetic
• a suitable generator for this purpose is described in WO 2012/076844, which is incorporated herein by reference.
• the generator 102 is connected to a handpiece 106 by an interface cable 104.
• the handpiece 106 may also be connected to receive a fluid supply 107 from a fluid delivery device 108, such as a syringe, although this is not essential.
• the handpiece 106 may house an instrument actuation mechanism that is operable by an actuator 109, e.g. a thumb operated slider or plunger.
• an actuator 109 e.g. a thumb operated slider or plunger.
• the instrument actuation mechanism may be used to operate the jaws of a forceps instrument as discussed herein.
• a blade and/or needle movement mechanism may be provided (operable by a suitable trigger on the handpiece) for moving a cutting blade or deploying a needle at the
• a function of the handpiece 106 is to combine the inputs from the generator 102, fluid delivery device 108 and instrument actuation mechanism, together with any other inputs which may be required, into a single flexible shaft 112, which extends from the distal end of the handpiece 106.
• the flexible shaft 112 is insertable through the entire length of an instrument (working) channel of a surgical scoping device 114.
• the flexible shaft 112 has an instrument tip 118 that is shaped to pass through the instrument channel of the surgical scoping device 114 and protrude (e.g. inside the patient) at the distal end of the endoscope's tube.
• the instrument tip 118 includes a pair of jaws for gripping biological tissue and an energy delivery structure arranged to emit microwave EM energy which is conveyed from the generator 102.
• the instrument tip 118 may also include a movable blade for cutting biological tissue, and/or a
• the handpiece 106 includes an actuation
• the handpiece 106 also includes a rotation mechanism for rotating the instrument tip 118 relative to the instrument channel of the surgical scoping device 114.
• the structure of the instrument tip 118 may be arranged to have a maximum outer diameter suitable for passing through the working channel.
• the diameter of a working channel in a surgical scoping device such as an endoscope is less than 4.0 mm, e.g. any one of 2.8 mm, 3.2 mm, 3.7 mm, 3.8 mm.
• the length of the flexible shaft 112 can be equal to or greater than 1.2 m, e.g. 2 m or more.
• the instrument tip 118 may be mounted at the distal end of the flexible shaft 112 after the shaft has been inserted through the working channel (and before the instrument cord is introduced into the patient) .
• the flexible shaft 112 can be inserted into the working channel from the distal end before making its proximal connections.
• the distal end assembly 118 can be permitted to have dimensions greater than the working channel of the surgical scoping device 114.
• the system described above is one way of introducing the instrument into a patient. Other techniques are possible. For example, the instrument may also be inserted using a catheter.
• Fig. 2a is a schematic diagram showing a perspective view of an instrument tip 200 of an electrosurgical forceps instrument that is an embodiment of the invention.
• the instrument tip 200 includes a first jaw 202 and a second jaw 204, each of which is pivotally mounted on an axle 206 such that they are movable relative to each other to open and close a gap between them.
• the jaws may be made of metal, e.g.
• the axle 206 is mounted on a rigid bracket 208 which protrudes from a distal end of an instrument shaft 210.
• the bracket 208 includes a mounting portion 212 which is shaped to extend into and close a distal end of the instrument shaft 210.
• the bracket 208 may be secured to the instrument shaft 210 with an adhesive or some other suitable means (e.g. ultrasonic welding) . In this manner, any torque applied to the instrument shaft 210 may be transmitted to the instrument tip 200.
• the instrument shaft 210 may comprises a hollow tube made of any suitable material, e.g. PTFE.
• the first jaw 202 includes a gripping portion 214 for gripping biological tissue and an actuation portion 216 for pivoting the jaw 202 about the axle 206.
• the gripping portion 214 and actuation portion 216 are located on opposing ends of the jaw 202, either side of the axle 206.
• the gripping portion 214 is located at a distal end of the instrument tip 200, whilst the actuation portion 216 is located closer to the instrument shaft 210.
• second jaw 204 includes a gripping portion 218 and an actuation portion 220 located on either side of the axle 206.
• the gripping portions 214 and 218 may each include serrated edges, to facilitate the gripping of biological tissue.
• the jaws 202 and 204 are pivotally mounted on the axle 206 such that a gap between the gripping portions 214 and 218 of the jaws can be varied (i.e. the gap can be opened and closed) . In use, this enables biological tissue to be gripped between the gripping portions 214, 218 of the jaws 202, 204.
• a first control wire 222 is connected to the actuation portion 216 of the first jaw 202, and a second control wire 224 is connected to the actuation portion 220 of the second jaw 204.
• the first and second control wires 222, 224 pass through the bracket 208 into the instrument shaft 210, and run along the entire length of the instrument shaft 210.
• the first and second control wires 222, 224 are connected at a proximal end of the electrosurgical instrument to a handpiece
• the control wires 222, 224 may pass through the bracket 208 via holes in the mounting portion 212 of the bracket 208.
• tubes made of a suitable material e.g. polyimide
• glue e.g. which is used during manufacture to glue the bracket 208 to the instrument shaft 210) from accidentally dripping onto the control wires 222, 224 and causing them to stick.
• the gripping portions 216, 220 each include a hole for receiving the first and second control wires 222, 224 respectively.
• the first and second control wires 222, 224 each include a hook at their distal ends for mechanically engaging the hole in actuation portions 216 and 220 respectively.
• Other manners of securing the control wires 222, 224 to the gripping portions 216, 220 are also possible.
• control wires may be glued, soldered or welded to the gripping portions.
• first and second control wires 222, 224 Longitudinal motion of the first and second control wires 222, 224 along the instrument shaft 210 causes the jaws 202, 204 to pivot about the axle 206, varying the gap between the gripping portions 214, 218 of the jaws. For example, if the first and second control wires 222, 224 are pushed along the instrument shaft 210 (i.e. they are pushed towards the instrument tip 200), the jaws 202, 204 pivot such that their gripping portions 214, 218 move away from each other, thus opening a gap between the gripping portions 214, 218.
• first and second control wires 222, 224 are pulled along the instrument shaft 210 (i.e. retracted away from the instrument tip 200), the jaws 202, 204 pivot such that their gripping portions 214, 218 move towards each other, thus closing the gap between them.
• the first and second control wires 222, 224 may be moved together along the instrument shaft 210, or they may be moved independently of one another. Moving the control wires together may cause the jaws to move symmetrically relative to a longitudinal axis of the instrument shaft 210. This may facilitate gripping of biological tissue between the jaws.
• one of the jaws may be fixed relative to the bracket 208 (i.e. it does not pivot relative to an axle) and only one of the jaws may be pivotally mounted on an axle. In such an example, there may be only a single control wire which is connected to the pivotally mounted jaw.
• Fig. 2b is a schematic diagram showing a different perspective view of instrument tip 200. Where features have already been described above in reference to Fig. 2a,
• a coaxial transmission line 226 passes through the instrument shaft 210.
• the coaxial transmission line 226 is serves to convey radiofrequency (RF) electromagnetic (EM and/or microwave EM energy from a generator (e.g. generator 102) to the instrument tip 200.
• RF radiofrequency
• EM electromagnetic
• microwave EM energy from a generator (e.g. generator 102) to the instrument tip 200.
• the coaxial transmission line 226 may be a conventional flexible coaxial cable, and includes an inner conductor separated from an outer conductor by a dielectric material.
• the coaxial transmission line 226 may also include a protective outer dielectric layer.
• the coaxial transmission line 226 terminates at a connector 228 located
• a first flexible microwave substrate 230 and a second flexible microwave substrate 232 are secured to the connector 228, e.g. using an adhesive.
• the connector 228 includes a pair of longitudinally extending ledges to which the flexible microwave substrates are secured.
• the flexible microwave substrates 230, 232 (which may also be referred to as electrode strips) may be made of any suitable flexible dielectric material.
• the flexible microwave substrates 230, 232 might be RFlex microwave substrate from Rogers Corporation.
• the first flexible microwave substrate 230 extends from the connector 228 and passes through an aperture in the mounting portion 212 of the bracket 208. A distal portion of the first flexible microwave substrate 230 is secured to an inner surface 234 of the first jaw 202.
• the second flexible microwave substrate 232 extends from the connector 228, passes through an aperture in the mounting portion 212 of the step 208, and is secured at a distal portion to an inner surface 236 of the second jaw 204. Note that for illustration purposes, the first and second flexible microwave substrates 230, 232 are not shown as being secured to the inner surfaces of jaws 202, 204; they are shown in a state before they are secured to the inner surfaces of the jaws 202, 204.
• the flexible microwave substrates may be secured to the inner surfaces of the jaws 202, 204 using any suitable bonding or fixing method. For example, they may be attached by an adhesive. Alternatively, the flexible microwave substrates may be secured to their respective inner surface using solder.
• Fig. 2b shows a patch of solder 238 applied to an underside of the second flexible microwave substrate 232. Solder flux (not shown) is applied to the inner surface 236 of the jaw 204. The second flexible microwave substrate 232 may then be bonded to the inner surface 236 by pressing the second flexible
• microwave substrate 232 onto the inner surface 236 and heating the jaw 204 (e.g. with the tip of a soldering iron), which causes the solder to flow and distribute itself evenly between the second flexible microwave substrate 232 and the inner surface 236.
• flexible microwave substrates 230, 232 are not depicted in Fig. 2a.
• a microwave emitter structure is formed on the distal portion of each of the flexible microwave substrates 230, 232.
• Fig. 2b shows for example microwave emitter structure 240 on the distal portion of flexible microwave substrate 230.
• Each microwave emitter structure is connected to receive microwave EM energy from the coaxial transmission line via conductive paths on the flexible microwave substrates.
• Each microwave emitter structure may be configured to emit microwave EM energy into biological tissue gripped between the jaws 202, 204.
• one or both of the microwave emitter structures may be a coplanar microstrip antenna having an active strip and a ground strip.
• the flexible microwave substrate may include two conductive paths: a first conductive path connecting the inner conductor of the coaxial transmission line 226 to the active strip and a second conductive path connecting the outer conductor of the coaxial transmission line 226 to the ground strip.
• Other types of microwave emitter structure are also possible.
• the instrument tip 200 may include a single microwave emitter structure which is split between the two jaws 202, 204.
• an active strip which is connected to the inner conductor of the coaxial transmission line 226 may be formed on the distal portion of the first flexible microwave substrate 230, whilst a ground strip connected to the outer conductor of the coaxial transmission line 226 may be formed on the distal portion of the second flexible microwave substrate 232.
• the instrument tip 200 may include a single microwave emitter structure formed on a single jaw. In such a case, it may only be necessary to provide a single flexible microwave substrate
• the microwave emitter structure and conductive paths on flexible microwave substrate may be formed of a conductive material which is deposited on the flexible microwave substrate.
• the emitter structure and conductive paths may be formed of a metal which is printed onto the flexible microwave substrate.
• substrates therefore serve both to provide a support for the microwave emitter structures, and to connect the microwave emitter structures to the coaxial transmission line 226.
• the flexible microwave substrates are flexible, they bend when the jaws 202, 204 are opened and closed, thus allowing movement of the jaws whilst maintaining the
• connection between the microwave emitter structures and the coaxial transmission line 226 may take place mainly near the distal portions of the flexible microwave substrates, which are secured to the jaws 202, 204. This avoids putting large mechanical stresses on the connections between the connector
• the 212 of the bracket 208 through which the flexible microwave substrates 230, 232 pass may be arranged to restrict movement of the flexible microwave substrates 230, 232 relative to the instrument shaft, in order to reduce mechanical stresses experienced at the connector 228 due to bending of the flexible microwave substrates 230, 232.
• the instrument tip 200 may thus be used to seal
• biological tissue e.g. a blood vessel held between the jaws 202, 204, by applying microwave EM energy to the biological tissue with the microwave emitter structure.
• Fig. 2c is a schematic diagram showing a perspective view of instrument tip 200, together with a length of the
• the first and second control wires 222, 224 are connected to a single main control wire 242 part way along the instrument shaft 210.
• the first and second control wires 222, 224 may for example be glued, welded or soldered to the main control wire 242. In this manner, a longitudinal motion of the main control 242 along the
• instrument shaft 210 may be transmitted to the first and second control wires 222, 224, causing the jaws 202, 204 to move.
• the main control wire 242 runs along the instrument shaft 210 between the first and second control wires 222, 224 and the handpiece (discussed in more detail below) .
• the first and second control wires 222, 224 are connected to the main control wire 242 near the distal end of the instrument shaft 210, such that only a single control wire (namely the main control wire 242) runs along most of the length of the instrument shaft 210. This may simplify construction of the electrosurgical instrument.
• the coaxial transmission line 226 and the main control wire 242 enter a wire holder 244 having a first passage in which a portion of the coaxial transmission line 226 is contained and a second passage in which a portion of the main control wire 242 is contained.
• the wire holder 244 serves to fix the lateral positions of the coaxial transmission line 226 and main control wire 242 relative to one another, whilst allowing the main control wire 242 to move longitudinally along the instrument shaft 210.
• the wire holder 244 therefore prevents the coaxial transmission line 226 and main control wire 242 from becoming tangled or twisted inside the instrument shaft 210, which could affect the accuracy with which opening and closing of the jaws can be controlled.
• other wires e.g.
• the wire holder 244 may also include further passages for holding the additional wires and/or conduits.
• the wire holder may be made out of plastic, for example it may be an extrusion made of polyether ether ketone (PEEK) .
• the wire holder 244 may itself be contained within a tube 246 (e.g. a PEEK tube) .
• the tube 246 may have a split 248 along its length, to facilitate insertion of the wire holder into the tube 246.
• the tube 246 may act as padding between the wire holder 244 and an inner surface of the instrument shaft 210, in order to prevent the wire holder 244 from moving inside the instrument shaft 210. This may help avoid lag when pushing or pulling the main control wire 242 to move the jaws
• the distal ends of the wire holder 244 and tube 246 are spaced from the instrument tip 200 by a predetermined
• the instrument shaft 210 therefore includes a distal portion 250 between the instrument tip 200 and the distal ends of the wire holder and tube 246 where there is no wire holder 244 or tube 246.
• the wire holder 244 and tube 246 may extend along the instrument shaft 210 most or all of the length between their distal ends and the handpiece.
• the distal portion 250 of the instrument shaft 210 may therefore have increased flexibility compared to the rest of the instrument shaft 210. This may improve the manoeuvrability of the instrument shaft 210, as it may enable the distal portion 250 to be guided through tightly bending passageways.
• the lack of a wire holder 244 and tube 246 in the distal portion 250 also serves to provide space for the connection between the first and second control wires 222, 224 and the main control wire 242.
• the length of the distal portion 250 of the instrument shaft 210 may be 150 mm.
• Figs. 3a and 3b show perspective views of another instrument tip 300 of an electrosurgical instrument according to the invention.
• the instrument tip 300 includes a first jaw 302 and a second jaw 304 pivotally mounted on an axle 305.
• the first and second jaws 302, 304 include gripping portions 306, 308 respectively for gripping biological tissue between them.
• jaws 302, 304 also include actuation portions to which control wires (not shown) are attached, in order to open and close the jaws.
• the first jaw 302 includes a blade 306 which is movable along a longitudinally extending slot 308 in the jaw 302.
• the blade may be moved backwards and forwards along the slot 308 by means of a control wire (not shown) attached to the blade 306 and which runs through the instrument shaft to the handpiece.
• the first jaw 302 further includes a cover 310 at its distal end, into which the blade 306 can be retracted so that it is not exposed. Thus, when the blade 306 is not in use, it may be retracted into the cover 310 in order to avoid unintentionally cutting any tissue.
• the blade 306 may be biased towards a retracted position where it is concealed by the cover 310.
• the second jaw 304 includes a microwave emitter structure
• the microwave emitter structure 312 may be arranged to emit microwave EM energy into tissue gripped between the jaws 302, 304.
• the second jaw 304 further includes a slot 316 for receiving the blade 306.
• the slot 316 passes through part of the microwave emitter structure 312 and the flexible microwave substrate 314, such that the active electrode 315 is split into two prongs, as illustrated in Fig. 3c which shows a schematic diagram of second jaw 304.
• the slot 316 passes through part of the microwave emitter structure 312 and the flexible microwave substrate 314, such that the active electrode 315 is split into two prongs, as illustrated in Fig. 3c which shows a schematic diagram of second jaw 304.
• 316 on the second jaw 304 is aligned with the slot 308 on the first jaw, such that when the jaws are brought together, the blade 306 may be received in slot 316 of the second jaw 304 and moved backwards and forwards along the slot 316.
• Both slots 308 and 316 are oriented in the longitudinal direction (i.e. along an axis of the instrument shaft) .
• the blade 306 includes a cutting edge 318 which faces inwards, towards the axle 305. In this manner, biological tissue held between the jaws 302, 304 may be cut by pulling the blade along the slot 308 towards the axle 305.
• the maximum length of cut which can be achieved with instrument tip 300 is determined by the length of the jaws 302, 304 and of slots 308 and 316, as these determine the range of motion of the blade 306. Longer slots 308, 316 may enable longer cuts to be performed.
• the jaws 302, 304 are then opened using the control wires.
• Biological tissue which is to be cut is then placed between the jaws 302, 304, and the jaws are closed so that the biological tissue is gripped between them.
• microwave EM energy is applied to the biological tissue in order to cauterise the biological tissue.
• the blade 306 may be pulled along the slot 308 towards the axle 305 in order to cut the biological tissue held between the jaws 302, 304. As the biological tissue was cauterised prior to its being cut, bleeding may be avoided.
• Figs. 4a, 4b and 4c are schematic diagrams illustrating a safety mechanism 400 that may be used for moving blade 306 along slot 308 in instrument tip 300.
• the mechanism 400 ensures that there is always a push force applied to the blade 306, such that it is biased towards the retracted position, where it is concealed by the cover 310.
• the safety mechanism 400 may be located inside the instrument shaft, near a distal end of the instrument shaft where the instrument tip is connected. For illustration purposes, the instrument shaft is not depicted in Figs. 4a, 4b and 4c.
• Figs. 4a, 4b and 4c show the coaxial transmission line 402 of the electrosurgical instrument, for conveying microwave EM energy to the instrument tip. Also shown are first and second control wires 404 and 406 for opening and closing the jaws of the instrument tip, as discussed above.
• a third control wire 408 runs through the instrument shaft for moving the blade 306 backwards and forwards along slot 308. Moving third control wire 408 longitudinally along the instrument shaft causes the blade 306 to move along the slot 308.
• the safety mechanism 400 includes a proximal ring 410 and a distal ring 412 spaced by a helical spring 414.
• transmission line 402 passes through the proximal and distal rings 410, 412 and the helical spring 414.
• the distal ring 412 is located closer to the instrument tip than the proximal ring
• Both the proximal and distal rings 410, 412 have three grooves: one for receiving the first control wire 404, one for receiving the second control wire 406 and one for receiving the third control wire 408.
• Figs. 4b and 4c show magnified views of the proximal and distal rings 410, 412, respectively.
• the first and second control wires 404, 406 are secured to the proximal ring 410 such that they are fixed relative to the proximal ring 410 (i.e. they are not slidable in their respective grooves relative to the proximal ring) .
• the first and second control wires 404, 406 may be glued or soldered to the proximal ring 410.
• the first and second control wires 404, 406 are not fixed relative to the distal ring 412, such that they are slidable in their grooves relative to the distal ring 412.
• the third control wire 408 is not fixed relative to the proximal ring
• the third control wire 408 is however fixed relative to the distal ring 412, such that it is not slidable in its groove relative to the distal ring.
• the proximal and distal rings 410, 412 are not fixed relative to the coaxial transmission line 402, and can slide relative to the coaxial transmission line 402.
• the safety mechanism 400 may be arranged such that the spring 414 provides a biasing force that urges the proximal ring 410 and the distal ring 412 apart.
• the longitudinal travel of the proximal ring 410 in the proximal direction is limited by the jaws. When the jaws are closed, the proximal ring 410 cannot travel further back along the shaft because is it fixed to the first and second control wires 404, 406. With no external force on the third control wire 408, the
• separation of the proximal ring 410 and the distal ring 412 determined by the spring may be such that the blade is still retained in the cover when the proximal ring 410 is in this position.
• the blade can then be moved by applying a force to the third control wire 408 that compresses the spring to permit the distal ring 412 to move closer to the proximal ring
• the longitudinal travel of the distal ring 412 in the distal direction may be limited by the cover, which present a physical block to distal movement of the blade.
• the distal ring 412 cannot travel further forward along the shaft because is it fixed to the third control wire 408.
• the jaws may still be opened in this scenario by applying a force to the first and second control wires 404, 406 that compresses the spring to permit the proximal ring 410 to move closer to the distal ring
• proximal ring 410 may be fixed relative to the coaxial transmission line 402, and the first and second control wires 404, 406 may be slidable relative to the proximal ring 410.
• the distal ring 412 may be configured as described above for safety mechanism 400. Then, the compression of the spring 414 acts as described above to bias the blade 306 towards the retracted position, but does exert any force on the first and second control wires 404, 406 to bias the position of the jaws 302, 304.
• the instrument tip of the electrosurgical instrument of the invention may be configured to perform functions in addition to vessel sealing.
• the instrument tip may have an auxiliary radiofrequency (RF) dissector element mounted on a distal tip thereon.
• Fig. 5 shows an example of an instrument tip 500 according to the invention, having a pair of jaws 502, 504 and an RF dissector element 506 mounted on a distal end of jaw 502.
• the RF dissector element 506 is a bipolar structure that comprises an active electrode mounted in a ceramic tube 508, and a return electrode, which may be fabricated on or integrated with the jaw 502 in the vicinity of the ceramic tube 508.
• a groove is provided on an upper surface of the jaw 502 to receive the ceramic tube 508.
• the dissector element 506 is connected to an RF transmission wire 510 which runs through the instrument shaft 512, and which is arranged to convey RF EM energy from an RF EM energy generator located at a proximal end of the electrosurgical instrument.
• the RF transmission wire 510 may be a copper wire contained in a PTFE jacket.
• the RF dissector element 506 can be used for fine bloodless tissue cutting and tissue dissection.
• the RF dissector element 506 presents a leading edge that sits proud of the distal end of the jaw 502. This position can enable both side and end-on dissection to be performed.
• dry field treatment scenarios i.e. in the absence of saline or other electrically
• the return electrode it is desirable for the return electrode to be in close proximity to the active electrode that is on the
• the ratio of the exposed tissue contacting electrode areas is also important to ensure that current flow occurs in a desired manner that causes maximum current density to occur on the leading edge of the RF dissector element 506.
• RF dissector element 506 is shown at the distal end of the jaw 502 in Fig. 5, it can be mounted in a variety of orientations or locations on the distal end assembly, e.g. vertically, horizontally, at an angle, on one side, and on either jaw.
• Fig. 6a is an illustration of a handpiece 600 which may be used as part of an electrosurgical apparatus that is an embodiment of the invention.
• the handpiece 600 includes a body 602 and an actuating portion 604.
• the body 602 includes a hollow barrel 606 in which a shaft 608 of the actuating portion 604 is slidably engaged.
• the body 602 also includes a rotator 610 which is rotatably connected to the barrel 606.
• the actuating portion 604 is connected to an internal shaft 628 which extends through the barrel 606 and rotator 610, and which protrudes from a distal end of the rotator 610.
• the internal shaft 628 moves longitudinally with the shaft 608, but is rotatable relative to it.
• An instrument shaft 612 exits the handpiece 600 from a distal end of the internal shaft 628.
• the instrument shaft 612 may be instrument shaft 210 described above, which is connected to an instrument tip at its distal end.
• the instrument shaft 612 is connected to rotate with the internal shaft 628.
• the actuating portion 604 is slidable in a longitudinal direction relative to the body 602 along its shaft 608 between two positions: a closed position where a length of the shaft 608 is contained within the barrel 606, and an open position where the length of the shaft 608 is outside the barrel 606.
• Fig. 6a shows the handpiece 600 with the actuating portion 604 in the open position.
• the total range of motion of the actuating portion 604 relative to the body 602 may be
• the longitudinal direction of motion of the actuating portion 604 relative to the body 602 is aligned with a longitudinal axis of the instrument shaft 612 as is passes out of the internal shaft 628.
• the shaft 608 may include one or more grooves 614 which engage with protrusions (not shown) inside the barrel 606, in order to prevent the actuating portion 604 from rotating relative to the body 602.
• the body 602 includes a pair of finger rings 614, 616 and the actuating portion 604 includes a thumb ring 618, which may be used to facilitate a user' s grip when moving the actuating portion 604 relative to the body 602.
• the actuating portion further includes an input connector 620 for connecting an interface cable (e.g. interface cable 104) which connects the handpiece 600 to a generator (e.g. generator 102) .
• the input connector 620 may for example be a QMA connector or any other suitable connector for interfacing with the generator.
• Fig. 6b is a cut-away illustration of the handpiece 600, where certain parts are not shown in order to reveal the internal structure of the handpiece. Where features have already been described above in reference to Fig. 6a,
• the input connector 620 is electrically connected to a circuit board 622 contained within the shaft 608 of the actuating portion 604.
• the input connector 620 forms a substantially right angle with the circuit board 622, such that it is oriented along a direction which is substantially perpendicular to the direction of relative motion between the actuating portion and the body 602. In this manner, a cable which is connected to the input connector 620 may not get in a user's way.
• An output connector 624 is attached at an edge of the circuit board 622.
• the circuit board 622 contains a circuit which is configured to block RF EM energy input into the input connector 620, and transmit any microwave EM energy input into the connector 620 to the output connector 624.
• the output connector 624 is electrically connected to a coaxial transmission line 626 via a mating connector 627 on the coaxial transmission line 626.
• the coaxial transmission 626 line runs through the handpiece 600 and enters the instrument shaft 612 at the distal end of the handpiece 600.
• the coaxial transmission line 626 may for example correspond to coaxial line 226 described above, which serves to convey microwave EM energy to the instrument tip.
• the circuit board 622 therefore provides a safety mechanism which prevents RF EM energy from unintentionally being conveyed to the coaxial transmission line 626.
• the circuit board 622 is described in more detail below .
• the electrical connection between the output connector 624 and the coaxial transmission line 626 is rotatable, i.e. it allows the coaxial transmission line to rotate about its axis relative to the output connector 624.
• Suitable connectors which enable rotatable electrical connections include QMA connectors, micro coaxial (MCX) connectors and micro-miniature coaxial (MMCX) connectors.
• the internal shaft 628 extends through and is longitudinally slidable relative to both the barrel 606 and the rotator 610 of the body 602.
• a distal end of the internal shaft 628 protrudes from the rotator 610.
• the length of the protruding portion depends on the position of the shaft 608 of the actuating portion 604.
• the internal shaft 628 is connected at a proximal end to the shaft 608 of the actuating portion 604, by means of a circumferential recess 630 around an outer surface of the internal shaft 628 which is engaged by a radial protrusion 632 on an inner surface of the shaft 608.
• the connection between the shaft 608 and the internal shaft 628 prevents the internal shaft 628 from moving longitudinally relative to the shaft 608, but allows the internal shaft 628 to rotate about its axis relative to the shaft 608.
• the internal shaft 628 may
• the internal shaft 628 may include a proximal portion 631 having a cavity for holding the connector 627 of the coaxial transmission line 626 in position to ensure that it remains securely connected to the output connector 624 on the circuit board 622.
• the connector 627 on the coaxial transmission line 626 may include a protrusion 633 which is configured to engage a slot in the proximal portion 630 of the internal shaft 628, to prevent the connector 627 from moving relative to the internal shaft 628.
• the connector 627 on the coaxial transmission line 626 may include a protrusion 633 which is configured to engage a slot in the proximal portion 630 of the internal shaft 628, to prevent the connector 627 from moving relative to the internal shaft 628.
• protrusion 633 may be a nut which is part of or attached (e.g. by soldering) to the connector 627.
• the protrusion 627 may also be configured to rotationally lock the connector 627 to the internal shaft 628, such that rotation of the internal shaft 628 causes the connector 627 to rotate.
• the coaxial transmission line 626 passes through the internal shaft 628 where, at a distal end thereof, it enters the instrument shaft 612. A length of the instrument shaft 612 is contained within a distal portion 634 of the internal shaft
• the instrument shaft 612 may be glued using epoxy to the distal portion 634 of the internal shaft 628.
• Adhesion between the instrument shaft 612 and the internal shaft 628 may be improved by roughing the surface of the instrument shaft 612 before applying the epoxy.
• the length of instrument shaft 612 contained in the distal portion 634 may be approximately 22 mm, to ensure good adhesion .
• the rotator 610 is connected to the barrel 606 such that it is rotatable relative to the barrel about a longitudinal axis of the handpiece 600.
• the rotator 610 has a proximal portion 642 with a circumferential recessed channel 644 that receives a radially inwardly extending protrusion 646 on the barrel 606.
• the internal shaft 628 passes through the rotator 610 and is engaged with the rotator 610 such that it is slidable relative to the rotator 610 along its length, but it is not rotatable relative to the rotator 610 (i.e. the rotator 610 and internal shaft 628 are rotationally locked relative to one another) .
• This may be achieved by any kind of interengagement that transfers rotational movement.
• there may be one or more longitudinally oriented cooperating engagement elements (e.g. grooves and teeth) formed on an outer surface of the internal shaft 628 and an inner surface of the rotator 610.
• the engagement elements may respectively engage with each other to cause the internal shaft 628 to rotate as the rotator 610 is turned on the barrel 606. This in turn causes the instrument shaft 612, which is fixed to the internal shaft
• the axis of rotation of the rotator 610 relative to the barrel 606 may be aligned with a longitudinal axis of the internal shaft 628, such that rotation of the rotator 610 causes rotation of the internal shaft 628 about its longitudinal axis.
• a length of a main control wire 636 is contained within the internal shaft 628, and exits the handpiece through the instrument shaft 612.
• the main control wire 636 may be used to open and close jaws on an instrument tip connected at a distal end of the instrument shaft 612.
• main control wire 636 may correspond to main control wire 242 described above.
• a proximal end of the main control wire 636 is held fixed relative to the body 602 of the handpiece 600.
• motion of the body 602 relative to the actuating portion 604 may cause the main control wire 636 to move longitudinally along the instrument shaft 612.
• the longitudinal position of the instrument shaft 612 is held fixed relative to the actuating portion 604 (by means of the internal shaft 628, which is connected at one end to the actuating portion 604 and at another end to the instrument shaft 612), whilst the main control wire 636 is movable with the body 602 relative to the actuating portion 604, and thus the instrument shaft 612.
• a user may move the actuating portion 604 relative to the body 602 in order to move the main control wire 636 backwards and forwards relative to the instrument shaft 612 and control the opening and closing of jaws on an instrument tip connected at a distal end of the instrument shaft 612.
• a block 638 is attached to the proximal end of the main control wire 636.
• the block 638 may for example be a piece of metal which is soldered or welded to the proximal end of the main control wire 638.
• the block 638 may be configured to fit in a holder (not shown) which is rigidly connected to the rotator 610, such that longitudinal motion of the body 602 relative to the actuating portion 604 is transmitted to the block 638 (and hence the main control wire 636) via the holder.
• the holder may be connected to the rotator 610 through an opening in a side wall of the internal shaft 628.
• a portion of the main control wire 636 in the internal shaft 628 may be contained in a protective tube 640.
• the protective tube may be made of any suitable material (e.g. PTFE) , and may serve to prevent the main control wire 636 from bending when the handpiece 600 is opened.
• a metal tube may be soldered or welded to the main control wire 636 to achieve the same effect.
• the relative linear motion between the actuating portion 604 and the body 602 directly controls linear motion of the main control wire 636 relative to the instrument shaft 612.
• the configuration of the handpiece 600 enables a user to comfortably hold the handpiece 600 in one hand and control the opening and closing of the jaws with one hand (by placing fingers of one hand in the finger rings 614, 616, 618) .
• the user may also simultaneously rotate the rotator 610 with the other hand, in order to rotate the instrument tip.
• the orientation of the input connector 620 may ensure that any cable connected to the input connector 620 does not interfere with a user' s operation of the handpiece 600. In this manner, the user isn't forced to hold the handpiece 600 in an awkward position in order to accommodate a cable, which might cause stress on the user's wrist.
• RF blocking circuit board Fig. 7a shows a schematic diagram of a top view of an upper surface of the circuit board 700 which may be contained in a handpiece of an electrosurgical instrument that is an embodiment of the invention.
• circuit board 700 may correspond to circuit board 622 discussed above in relation to handpiece 600.
• Fig. 7b shows a perspective view of a lower surface of the circuit board 700, whilst Fig. 7c shows perspective view of a upper surface of the circuit board 700.
• the circuit board 700 includes an input connector 702 mounted on its lower surface, and an output connector 704 mounted near an edge of the circuit board 700.
• the circuit board 700 contains a RF blocking circuit on its upper surface which is configured to transmit microwave EM energy from the input connector 702 to the output connector 704, whilst blocking any RF EM energy from being transmitted from the input connector 702 to the output connector 704.
• the RF blocking circuit on the circuit board 700 includes a main strip line 706.
• An inner (active) conductor of the input connector 704 is electrically connected to the main strip line 706 at a connection point 708.
• a hole through the circuit board 700 may be provided so that the inner conductor of the input connector 704 can be electrically connected to the main strip line 706.
• the main strip line 706 is connected at a distal end to an inner conductor 710 of the output connector 704. There is a break in the main strip line 706, dividing the main strip line 706 into a first portion 712 and a second portion 714.
• the first and second portions 712, 714 of the main strip line 706 are connected by an RF blocking capacitor 716, which is arranged to block RF EM energy from being transmitted along the main strip line 706 to the output connector 704.
• the RF blocking capacitor 716 may have a capacitance of
• the upper and lower surfaces of the circuit board 700 each include a respective ground plane 718 and 720.
• Ground planes 718 and 720 may for example be layers of metal which cover most of the upper and lower surfaces respectively.
• the main strip line 706 is isolated from the ground plane 718 by an isolating barrier 722 which surrounds the main strip line
• the ground plane 720 on the lower surface is electrically connected to an outer shell of the input
• the output connector 704 is mounted on the circuit board 700 such that an outer shell of the output connector 704 is electrically connected to both ground planes 718 and 720.
• the outer shell of the input connector 702 may be configured to be connected to a ground of a generator (e.g. generator 102 via interface cable 104) . In this manner, the ground planes 718, 720 and the outer shell of the output connector 704 may be grounded through a generator connected to the input connector 702.
• the RF blocking circuit on the upper surface may further include a stub 724 which branches off from the main strip line 706 before the RF blocking capacitor 716.
• a microwave shorting capacitor 726 may be located on the stub 724 approximately one quarter-wavelength (with respect to the wavelength of
• the microwave shorting capacitor 726 is connected between the stub 724 and the ground plane 718, and acts as a short to ground for microwave EM energy. In this manner, the stub appears like a microwave open circuit at the main strip line
• the microwave shorting capacitor 726 may have a similar capacitance to the RF blocking capacitor 716. After the microwave shorting capacitor 726 there is a load resistor 728 connected between the stub 724 and the ground plane 718. Any RF EM energy fed into the RF blocking circuit must pass into the load resistor 728 where it may be dissipated, as RF EM energy is blocked from passing along the main strip line 706 by the RF blocking capacitor 716.
• the resistance of the load resistor 728 may be selected such that it causes a generator connected to the circuit board 700 to produce an error signal if RF EM energy is accidentally fed into the RF blocking circuit.
• the load resistor 728 may for example have a
• RF blocking capacitor 716 and microwave shorting capacitor 726 may be selected such that they provide a reasonably low impedance at microwave
• capacitors 716 and 726 should appear close to a short at microwave
• the RF blocking circuit may thus provide a good match for the microwave energy into the output 704.
• the circuit board 700 may be made from any suitable circuit board material.
• the circuit board may be made from RO3006 laminate from Rogers Corporation. This material has a dielectric constant of around 6, allowing the design of the circuit board 700 to be miniaturised.
• the circuit board 700 may further include a series of vias 730 placed along the main strip line 706 and stub 724, in order to reduce interference caused by stray radiation.
• the vias 730 may be through-holes in the circuit board.
• a shielding enclosure e.g. made of metal
• the circuit board 700 may also be
• circuit board 700 is contained in a handpiece (e.g. handpiece 600), it may be possible to shield the circuit board 700 by applying a metal coating to an internal surface of the handpiece, such that the circuit board 700 is partially or totally surrounded by the metal coating when it is mounted in the handpiece.
• the circuit board 700 serves as an added safety mechanism to ensure that RF EM energy is not accidentally fed into the electrosurgical instrument.
• the circuit board 700 and prevents RF EM energy from being transmitted from a generator to an instrument tip, where unwanted RF EM energy could cause damage to a patient.
• the circuit board is directly integrated with the handpiece of the electrosurgical instrument, it is effective even in situations where the user is misusing the electrosurgical instrument (e.g. when the user has connected the wrong generator to the handpiece) .
• circuit board 700 is shown by way of example only, and circuit boards having alternative configurations may also be used to achieve the same effect.
• Fig. 8A is a schematic side view of one example of an energy delivery structure 800 that can be used in an
• the stripline comprises a flexible planar structure comprising a centre conductor layer 822 separated from a pair of ground plane layers 818, 826 of opposing sides thereof by a pair of flexible dielectric layers 820, 824.
• the ground plane layers are covered on their outermost surfaces (i.e. the surfaces facing away from the centre conductor layer 822) by respective dielectric (insulating) cover layers 816, 828.
• each flexible electrode strip 804 is connected to a distal end of the coaxial cable 808 at a connector 806.
• the connector 806 may be a sleeve or tube that lies over a region of overlap between the flexible electrode strips 804 and the coaxial cable 808.
• the coaxial cable 808 comprises an inner conductor 810 separated from an outer conductor 812 by a dielectric material 811.
• the inner conductor 810 and dielectric material 811 protrude beyond a distal end of the outer conductor 812.
• the inner conductor 810 is electrically connected to a conductive contact block 814 which in turn is electrically connector to an exposed portion of a centre conductor 822 within each flexible electrode strip 804.
• the centre conductor may be exposed by cutting away, etching or otherwise removing a section of the first cover layer 816, lower ground plane layer 818 and first flexible dielectric layer 820 in the region of contact with the conductive contact block 814.
• the outer conductor 812 is electrically connected to one of the ground plane layers, e.g. by exposing a distal portion of an upper ground layer 826 and bringing it into electrical contact with the outer conductor 812, e.g. via a conductive layer on the inner surface of the connector 806.
• the ground plane layers 818, 826 may be electrically connected to each other by one or more vias (not shown) filled with conductive material that extend through the flexible
• the dielectric layers 820, 824 in side regions of the stripline where the centre conductor does not exist.
• the width of the centre conductor layer 822 may be less than the width of the ground plane layers 820, 824 along the length of the stripline. This means that the ground plane layers 820, 824 extend width-wise beyond a side edge on the centre conductor layer on one or both sides thereof.
• the vias may be formed between the ground plane layers 820, 824 in this side zone .
• the centre conductor layer 822 and one or both of the ground plane layers may be exposed to form the electrodes discussed above.
• a stripline in the electrode strips provides a more isolated energy delivery structure than the microstrip arrangement discussed above.
• the energy is almost completely contained between the two ground plane layers 820, 824 so that no signals are exposed to the external surfaces.
• An advantage of this arrangement is that the presence of saline or other conductive fluid around the distal tip of the instrument does not adversely affect energy delivery. This advantage is demonstrated by the graph shown in Fig. 8B, where the line 830 indicating return loss in the presence of saline is very similar to the line 832 indicating return loss in tissue. This is further supported by the power absorption breakdown in each scenario:
• Figs . 9A and 9B show top and bottom views of an example electrode strip 900 suitable for use in the energy delivery structure of Fig. 8A.
• the electrode strip 900 comprises an elongate planar stripline 904 having shaped distal and proximal ends where it connects to a respective jaw and coaxial cable respectively.
• Fig. 9C is a magnified cross-sectional view through the stripline 904.
• the transmission line structure itself is formed from a pair of flexible laminated dielectric substrates 915, 916.
• Each laminated dielectric substrate comprises a flexible dielectric (e.g. polyimide) layer having a conductive material, e.g. copper, laminated on one or both surfaces thereof.
• the laminated conductive material can be given a desired shape on the substrate by etching or the like.
• an upper laminated substrate 915 comprises a first dielectric layer 918 and an upper ground plane layer 916.
• a lower laminated substrate 919 comprises a second dielectric layer 922, a centre conductor layer 920, and a lower ground plane layer 924.
• the upper laminated substrate 915 and the lower laminated structure are mounted together, e.g. using a (non-conductive) adhesive 928, so that the centre conductor layer 920 is sandwiched between the first and second dielectric layers 918, 922.
• the centre conductor layer 920 has a smaller width than the upper and lower ground plane layers 916, 924 to for a stripline.
• the upper laminated substrate 915 may be a single-sided laminate, or may be formed from a double-sided laminate by completely etching away one of the conductive surfaces.
• the transmission line is sandwiched between a pair of outer cover layers 914, 926, made of flexible insulating material, such as polyimide.
• the cover layer 914, 926 may be adhered to the adjacent surface of the stripline.
• the upper and lower ground plane layers 916, 924 are electrically connected by a series of vias 930 formed at proximal and distal ends of the electrode strip in the region spaced in the width direction from the centre conductor layer 920.
• the vias extend through the first and second dielectric layers 918, 922 between the upper and lower ground plane layers 916, 924 and carry conductive material to make an electrical connection.
• the proximal end of the electrode strip is adapted to enable the conductive layers to connect to a coaxial cable.
• the upper cover layer 914 is removed to expose a portion 906 of the upper ground plane layer 916, which in turn is electrically connected to an outer conductor of the coaxial cable, e.g. in a manner similar to that described above with respect to Fig. 8A.
• the lower cover layer 926, lower ground plane layer 924 and second dielectric layer 922 are removed to expose a portion 908 of the centre conductor layer 920, which in turn is electrically connected to an inner conductor of the coaxial cable, e.g. in a manner similar to that described above with respect to Fig. 8A.
• a channel 910 is removed from the three layers mentioned above in order to receive a length of the inner conductor that protrudes from a distal end of the coaxial cable.
• the centre conductor layer 920 does not extend to a proximal end of the electrode strip 900 to reduce or minimise energy loss at this junction .
• the distal end of the electrode strip 900 is adapted to provide the energy delivery electrode in the respective jaw.
• the upper cover layer 914 terminates before the distal end to expose a portion 902 of the upper ground plane layer 916, which in turn is electrically connected to its respective jaw.
• the lower cover layer 926, lower ground plane layer 924 and second dielectric layer 922 terminate before the distal end to expose a portion 912 of the centre conductor layer 920, from which energy is delivered.
• the exposed portion is set back from the edges of first dielectric layer 918 to control the shape of the emitted field.

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• 2017
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